Department of Internal Medicine, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
PLoS One. 2023 Jan 31;18(1):e0280871. doi: 10.1371/journal.pone.0280871. eCollection 2023.
Many studies have assessed the association between anemia and mortality in hemodialysis but few compared patients with and without diabetes. Our study aims to investigate the impact of hemoglobin and iron parameters on mortality in hemodialysis patients with or without diabetes.
This is a two-center retrospective study that included all adult patients who started hemodialysis between February 2012 and February 2020, followed until January 2021. Averages of hemoglobin, ferritin and transferrin saturation of entire follow-up were recorded. Kaplan Meier survival, log rank test and cox regression analyses were performed to assess the association between anemia biomarkers and mortality.
A total of 214 patients were included. Mean age was 67.98 ±12.41 years, mean hemoglobin was 10.92 ±0.75 g/dL, mean ferritin was 504.43 ± 221.42 ng/mL and mean transferrin saturation was 26.23 ±7.77%. Log rank test showed an association between hemoglobin ≥11 g/dL and better survival in patients without diabetes (P = 0.028). Based on cox regression analysis, hemoglobin was associated with all-cause mortality in all patients (HR = 0.66; CI:0.49,0.89; P = 0.007). When comparing patients with and without diabetes, this association remained significant only in patients without diabetes (HR = 0.53; CI:0.37,0.77; P<0.001). Based on different multivariate models, hemoglobin, ferritin and age were independent factors associated with mortality in patients without diabetes.
This study showed that hemoglobin ≥11 g/dL is associated with better survival in hemodialysis patients without diabetes but not in those with diabetes. These differences need to be further explored in other countries and settings. An individualization of the hemoglobin target level might be necessary to improve patients' outcomes.
许多研究评估了血液透析患者贫血与死亡率之间的关系，但很少有研究比较有糖尿病和无糖尿病患者。我们的研究旨在探讨血红蛋白和铁参数对有糖尿病和无糖尿病血液透析患者死亡率的影响。
这是一项回顾性的两中心研究，纳入了 2012 年 2 月至 2020 年 2 月期间开始血液透析的所有成年患者，随访至 2021 年 1 月。记录整个随访期间血红蛋白、铁蛋白和转铁蛋白饱和度的平均值。采用 Kaplan-Meier 生存分析、对数秩检验和 Cox 回归分析评估贫血生物标志物与死亡率之间的关系。
共纳入 214 例患者。平均年龄为 67.98 ± 12.41 岁，平均血红蛋白为 10.92 ± 0.75 g/dL，平均铁蛋白为 504.43 ± 221.42 ng/mL，平均转铁蛋白饱和度为 26.23 ± 7.77%。对数秩检验显示，无糖尿病患者血红蛋白≥11 g/dL 与生存较好相关（P = 0.028）。基于 Cox 回归分析，血红蛋白与所有患者的全因死亡率相关（HR = 0.66；95%CI：0.49，0.89；P = 0.007）。当比较有糖尿病和无糖尿病患者时，这种相关性仅在无糖尿病患者中仍然显著（HR = 0.53；95%CI：0.37，0.77；P<0.001）。基于不同的多变量模型，血红蛋白、铁蛋白和年龄是无糖尿病患者死亡的独立相关因素。
本研究表明，血红蛋白≥11 g/dL 与无糖尿病血液透析患者的生存较好相关，但与糖尿病患者无关。这些差异需要在其他国家和环境中进一步探讨。可能需要个体化血红蛋白目标水平以改善患者的预后。
